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Congestion in HFpEF — SCE Geriatric Medicine MCQ

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ModerateCardiovascular medicineCongestion in HFpEFSCE Geriatric Medicine

An 86-year-old woman with known HFpEF and frailty is admitted with worsening leg oedema and breathlessness. She has gained 4 kg, JVP is elevated, creatinine is 130 micromol/L from baseline 110 and albumin is 31 g/L. She takes furosemide 20 mg daily and amlodipine. What is the most appropriate management?

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Correct answer: C — Treat congestion with adjusted diuretic therapy and review contributing medicines such as amlodipine

Raised JVP, weight gain and breathlessness indicate congestion, so diuretic escalation and monitoring are appropriate despite a modest creatinine rise. Amlodipine can worsen peripheral oedema and should be reviewed. Fluids would worsen heart failure. The pearl is that mild renal deterioration during decongestion may be acceptable if perfusion and symptoms improve.

Reference: NICE NG106; BNF